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Home My WebLink About10209-z FOENI NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10~09 Z Permission is hereby granted to: ..Q. L2. ...... Zt)..Z /....~..L~ ..................................... .~.....~.~..:.L:.~:/..5~.....~.....~.L/.~. ~././.~. . .~.~o ~ ~ ,,/ premises located ......................................... ~,~ ...................................................................... ............ ..-.h.~:.~..a.~ ............................................ pursuant to application dated ................................ ./.4.~.i:....{..!....., 1~,.~....., and approved by the Building Inspector. Fee $. -Z( -~...~...~.~7.~ ........ ............. ............... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect Or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ..... ~7'/.;~./~. ~. ........... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property...z/.~..~ .~ .... ~...~r~..~../~.y./~ J.¢. ~. ......... ~ ./~. Ct, .V, .~m../ ............. House No. Street Hamlet Subdivision ................................. Map No ............... Lot No ....... ~, ...... Permit No./..,~. ~.'~. ~' Date of Permit L.q .... Health Dept. Apl~roval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $., ~] Construction on above described building and permit meets all applicable codes and regulations. Applicant .......................... Rev. 10-10-78 :~, ~ //.,~..,~ :~ Examined )J~'~ /! ? ? Approved )?d/' t /( /7 /Ir~ J?(~9 ~ ...... ................ 19... Permit No ............ Disapproved a/c .......... ...~. ...................... ........ .'. 7. ..... .... (Building Inspector) APPLICATION FOR BUILDING PERMIT TOWN OF $OUTHOLD BUILDING DEPARTMENT/~~ TOWN HALL SOUTHOLD, N-Y. 11971/~t~ ~,-2{ TEL.: 765-180:a Application No./, .. ~'. ............ Date ) ? fi / / I '-;~ ................... 19~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for ~nspection throughout the work, e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of ~he Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, o~ for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. + i' (Signature of al>plicant, or name, if a corporation) (Mailing address of applicant) "",' ? State whether applicarLt is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ...................... Other Trade's License No....~'.~.~. ............... Location of land on which proposed work will be d~e. .. '/. ?.. 7. ........... '..,"..'-.' .... '. House Number Street ' ~ Hamlet County Tax Map No. 1000 Section ........... Blo,,~k ....... ~. ......... Lot Subdivision ..................................... Fil'~d Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building'. ......... Addition .......... Alteration .......... Repai~ .............. Rem?al .............. Demolition .......... .,/9 Other Work ............... ~ ~ ~- n-t.o / 5,~ ,~o ~ ~ ~ ~ (Description) 4. Estimated Cost ...... O.1 ......................... Fee ...................................... ~' (to be p~d on filing this application) 5. If dwelling, number of dwelling ~nits ....... ~ ...... Number of dwelling units on each floor ................ If g~age, number of cars ..... [ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ D~en~ions of same structure with alterations or additions: Front ................. Rear .................. Dep~ ~ .................... ~.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Sto~es ........................................................ 9. Size of lot: Front ....... /lL.:7~ ........ Rear ./~ ~ ~.~ ............. Depth '. ..................... 10. Date of Purchase ........... 1 .................. Name of Fomer Owner ............................. 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... ~ .~ .................... Will excess fill be~emoyed f~om premises: ~es No 14. Nmne of Owner of premises ~g~ q ~.~44~.~ a Address~. F~~hone~ No ................ Nmne of Architect .......... [. ................ Address .......... 2'/~2~/.7~hone ~ ................ Nme of Contractor ~ ~.a r~, ~ ~ ~ fV.~..... Addres~*~:. ~~ Phone No. ~.~f ~. PLOT DIAGRAM Locate clearly ~d distinctlg ~1~ bufld~gs, whether existing or proposed, ~d, indicate all set-back dimensions from )rich accord~g to deed, and show street names ~d indicate whe~er property lines. Give street and block interior or corner lot. STATE OF NEW YORK, I.S COUNTY OF .................. (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the .................. i ...... i~;~;r a . ............ of said owner or owne~, ~d is dul~ authorized to perform or have perfomed the said work and to m~e ~d file this application; ,that all statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ne~ set forth ~ the application filed therewith. Sworn to before me this ......... } ........ f.[...day of: ........... ~d r.. ~, 19~ Nota~ Public, ................. ~ ................ County ~